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EMRs Can Reduce ED Visits, Hospitalizations For Diabetics

Using EMRs is associated with a drop in ED visits and hospitalizations among diabetics, according to a study covered in iHealthBeat.

The research, which appeared in the Journal of the American Medical Association, involved analyzing all of the 169,711 records for patients enrolled in Kaiser Permanente Northern California’s diabetes registry.

Researchers drew on data collected between 2004 and 2009. During this period, in 2005, KP began to stagger EMR implementations across the region’s 45 outpatient facilities, iHealthBeat reports.

The study found that EMR implementations were associated with the following results, according to iHealthBeat:

  • 10.50% decline in hospitalizations for preventable, ambulatory-care sensitive conditions, or about 7.08 fewer hospitalizations per 1,000 patients annually;
  • 6.14% decline in non-elective hospital admissions, or about 10.92 fewer admissions per 1,000 patients annually;
  • 5.54% decline in ED visits, from an expected 519.12 per 1,000 patients to 490.32 annually; and
  • 5.21% decline in hospital admissions, from an expected 251.6 per 1,000 patients to 238.5 annually

That being said, EMR implementation had no effect in certain areas. The number of physician office visits per year held steady at six; the frequency of times patients saw diabetic exacerbations remained level; and how often patients developed cardiovascular diseases remained the same, iHealthBeat noted.

The researchers concluded that these results represented not only an improvement in diabetes care, but also “the cumulative effect of EHRs across many different pathways and conditions.

This study is one of a growing body of evidence that effective EMR  use can reduce readmissions and improve outcomes.  For example, a recent study appearing in BMJ Quality & Safety recently concluded that EMRs can help reduce hospital readmissions of high-risk heart failure patients.

In that case, researchers used EMR-based software to sort high-risk from low-risk heart failure patients, using 29 clinical, social and behavioral factors within 24 hours of admission for heart failure. Using this tool, researchers were able to cut readmissions rates for the 1,700 adult inpatients study from 26.2 percent to 21.2 percent.

September 16, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

Patients Accessing Online Medical Records Use More Services

In previous postings, I’ve noted that for various reasons, doctors using EMRs are tending to bill for more E/M services.  This has CMS in a bit of a tizzy, and definitely deserves attention from the industry. (See also this post about EMR and Upcoding)

Now, a study appearing in the Journal of the American Medical Association seems to have identified another vector for increased use of services. According to the study, patients with online access to medical records and clinicians consume more clinical services than those without access.

The JAMA authors drew this conclusion after studying the consumption of clinical services by members of Kaiser Permanente Colorado, a group model IDS.  The Kaiser unit was studied from March 2005 through June 2010, reports Becker’s Hospital Report. 

What made the Kaiser unit a good choice was that not only did it have an EMR in place, it also launched a patient portal in May 2006 allowing patients secure access to health records details such as test results, care plans and active medications.

Researchers found that members who used the MyHealthManager portal, which gave access to the EMR, had increased rates of office visits, telephone encounters, after-hours clinic visits, emergency department encounters and hospitalizations during the study period.

I was surprised to find out that JAMA researchers generated this data, especially the ED and hospitalization rates, which seem to have to been markedly different between the two groups.

It did occur to me that perhaps the sickest patients are using the portal, or that those who aren’t using the portal aren’t very engaged in caring for their health, but such relationships are rarely that simple. Besides, the researchers did group patients by “propensity scores” which took patient age, sex, utilization frequencies and chronic illnesses, so we aren’t looking at populations that simply self-selected into the sicker and more healthy.

In any event, I’m glad I stumbled across this study and could share it with you. Knowing that these patterns exist, just in case they turn up in your health system. They’re certainly worth bearing in mind.

November 29, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.